Edward William Reicks, PH,D,

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 11010 Issued in CA

Practice address

1440 N Harbor Blvd
Suite 127
Fullerton, CA 92835-4114

Phone

(714) 879-7091

Fax

(714) 441-0914

NPI assigned

Jan 22, 2007

Last updated

Feb 2, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Dr. Ed William Reicks Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Enrique Friedman, M.D., Inc.

  • Psychiatry Physician
  • Fullerton, CA
  • NPI 1700987849
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328140800000",
    "number": "1083768733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 N HARBOR BLVD",
            "address_2": "SUITE 127",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928354127",
            "telephone_number": "714-879-7091",
            "fax_number": "714-441-0914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 N HARBOR BLVD",
            "address_2": "SUITE 127",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928354114",
            "telephone_number": "714-879-7091",
            "fax_number": "714-441-0914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REICKS",
        "first_name": "EDWARD",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "PH,D,",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2012-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 11010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CP11010",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "USBH",
            "identifier": "OPL 11010",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PSY 11010",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY11010",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ED",
            "last_name": "REICKS",
            "middle_name": "WILLIAM",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Clinical Psychologist in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.